Pregnancy and the Use of Sentinel Lymph Node Biopsy

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Breast cancer:
    • Is the most common pregnancy-associated malignancy
  • The ASCO recommends that pregnant patients:
    • Should not undergo SLNB based on the lack of safety data
  • Unfortunately, approximately 11% of pregnant patients with breast cancer who undergo ALND:
    • Develop lymphedema postoperatively:
      • Which has significant consequences on quality of life in these young women
  • This has led to increased interest in the use of SLNB for pregnant patients
  • Multiple studies have attempted to estimate the exposure of the fetus to radiation when using 99mTc to perform SLNB:
    • Conservative estimates suggest that fetal doses as low as 10 to 50 mGy:
      • Could increase the risk of malignancy in the fetus
    • Estimates suggest that fetal exposure during SLNB:
      • Is minimal at 1.14 mGy to 4.3 mGy:
        • Which is close to the levels of background radiation absorbed on an average day
    • Given this information, small studies have reported sentinel lymph node mapping with 99mTc in pregnant patients:
      • There have been no reported ill effects
    • Both methylene blue and isosulfan blue:
      • Are category C drugs in pregnancy:
        • With unknown levels of teratogenicity
    • Of 30 pregnant patients treated with SLNB using methylene blue:
      • One patient electively terminated her pregnancy and 29 gave birth to healthy infants
  • Safety conclusions are limited by small numbers and a lack of long-term follow-up data:
    • Some offer SLNB to pregnant patients:
      • Whereas others routinely perform ALND

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #Surgeon #Teacher #BreastCancer #BreastDiseases #AxillaryDissection #BreastSurgery #MountSinaiMedicalCenter #MSMC #Miami #Mexico #SLNM #SLNB #SentinelLymphNodeBiopsy

Unknown's avatar

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

Leave a comment